-Marty Indik
"If confusion is the first step to knowledge, I must be a genius."
-Larry Leissner
We passed by a KFC today. Take a look.
When I arrived at the hospital I was offered Chai. I had always been curious how it was prepared so I decided to watch.
I politely declined the chai. Then I declined some more. And some more. They thought that it was because the glass was dirty so they cleaned the glass. I declined again. Finally, I caved. I said, "What the heck, poor me some chai." I probably am a little anemic anyways. I could use the extra iron.
I did a lot of emergency training today. I brought along a CPR mannequin and we practiced CPR and advanced cardiac life support algorithms. It is a little challenging because they do not have ventilators in the facility so if they end up having to insert a breathing tube there will be no way to maintain it.
I went up to OB to do some mentoring. The OB doctor was with a patient and she asked me if I could come in and help out. I am not sure if it is because there is a language barrier, but every time I try and get a basic patient history it reminds me of the old Who's On First Abbott and Costello routine. It is almost comical how I get absolutely nowhere. I am absolutely stumped because I can not give any good recommendations. Here is how the encounter went. I will try and recreate it for you. Keep in mind the patient wore a burqa so I do not know what she looks like at all and all of the dialogue is through an interpreter.
OB: "OK, Doctor, this patient is infertile. She would like to get pregnant. She had a pelvic infection in the past and her husband has a low sperm count."
Me: "How old is she?"
OB: "35."
Me: "Does she have any children?"
OB: "She has 2 children."
Me: "So then she is not infertile. How long has she been trying to get pregnant?
Me: "So then she is not infertile. How long has she been trying to get pregnant?
OB: "Five years."
Me: "Well, if her husband has a low sperm count then that is probably the reason. There is not much that we can do about it."
OB: "He has been getting injections of testosterone."
OB: "He has been getting injections of testosterone."
Me: "Does he have low testosterone level?"
OB: "Why does it matter?"
Me: "Well, you should only get injections of testosterone if you are low in testosterone."
OB: "Should I give her a shot of antibiotics?"
Me: "Why would you give her a shot of antibiotics?"
OB: "Because she had a history of an infection?"
Me: "Is she having any symptoms?"
OB: "No."
Me: "Then why would you give her antibiotics?"
OB: "Do you have a scale?"
Me: "Why do you need a scale?"
OB: "You told me that you would bring me a scale."
Me: "But we are talking about your patient right now."
Me: "But we are talking about your patient right now."
OB: "What about Vitamin E?"
Me: "Why would you give Vitamin E? There are medications that can help with ovulation."
OB: "We do not have those medications."
Me: "Does she have regular periods?
Fast forward 5 minutes. We had a long discussion on what I meant by "regular periods."
Me: "Let me talk to the patient for a second. Now tell me why you have come to see the doctor today."
Patient: "5 years ago I had abdominal pain and I was told that I needed to have surgery. After the surgery I was told that I will never be able to have children again."
Me: "OB, that is very important detail that you failed to mention. Why did you not tell me that a surgeon said that she will never be able to get pregnant."
OB: "Oh, she is not sure."
OB: "Oh, she is not sure."
Me: "She does not know if she had a hysterectomy or a tubal ligation?"
OB: "It was right after the Taliban fell and the doctor did not tell her very much. She had appendicitis."
Me: "Oh, so she had appendicitis. They did not tie her tubes or do a hysterectomy."
OB: "She is not sure. So what should we do? Should I give her a shot of antibiotics?"
OB: "She is not sure. So what should we do? Should I give her a shot of antibiotics?"
Me: "Why would you give her a shot of antibiotics?"
OB: "Because she had a pelvic infection in the past."
Me: "But is she having any problems now?"
OB: "No."
OB: "No."
And on and on it went. Keep in mind you can not do an exam, you can only do very limited blood work (nothing relating to her problem), and you can not reliably do an ultrasound. Of course, in Afghanistan there is no in vitro fertilization. You can almost understand the OB doctor's frustration. She wants to give her something. If the patient walks out without any treatment then she will be dissatisfied with her care. I left leaving that problem unsolved.
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I have a theory that people back home are trying to make me fat. Why else would they send me so much food. These cookies were made by a culinary class from The Art Institute of Colorado. My base also send me 2 big boxes of delicious nuts, tropical fruit, peanut butter, candy, etc. My wonderful day care provider even sent me a bunch of goodies. I share everything with my teammates and some Afghans. Everyone appreciates all of the gifts. The beef sticks and the cheese will be served at the New Years party.
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Thanks for reading.